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Hong Kong may have seen a record cocaine bust last week, but the drug that really controls our city is ketamine. How did this tranquilising drug take hold of the streets? What is it about K that people crave? And how are the experts combatting ketamineaddiction?

Hong Kong is awash with ketamine. That’s the word on the street. Whether you know it as K, Kit-Kat, K-chai or ‘that horse tranquiliser the kids are hooked on’, it’s being snorted, sipped and swallowed in bars, clubs and homes in our city every day. But just what exactly is this drug that’s taken such a grip on Hong Kong?

Unlike other street drugs, ketamine has had a very short shelf life. It was first synthesised in 1962 and patented in Belgium in 1963. As an anaesthetic and analgesic, the drug has recognised therapeutic values in veterinary practice and, to a lesser extent, in human medicine. But for entertainment or relaxation purposes, ketamine has developed a far worse reputation. And nowhere more so than in Hong Kong.

Ketamine effects
There are a few ways to take ketamine. You can either snort it in powder form (by far the most popular), swallow it as a tablet (somewhat less popular), sip it in a cocktail (hardly ever done) or, more dangerously, combine it with cocaine (street name: ‘Calvin Klein’ or ‘CK1’) and, again, snort with a Hong Kong Dollar note. All these methods are widespread in Macau, Guangzhou, Shenzhen and especially Hong Kong. Indeed, such is ketamine’s popularity around our shores that drug experts both home and abroad freely admit that our city has now become the ketamine capital of the world.

About 90 percent of all ketamine purchased in Hong Kong will come in powder form. However, when it appears in the form of tablets, the concentration of the drug and other substances is mostly unknown by clubbers and users, and this poses unknown risks in recreational use.

So why is ketamine taken? It can cause perceptual changes or hallucinations like LSD, in addition to its effects on reducing bodily sensations. It can also produce vivid dreams, drowsiness, floating sensations and mild delirium in short doses. Users can trip for up to an hour from snorting a (large-ish) line and may feel the after-effects for some hours. It usually gives the user a floating feeling as if the mind and body have been separated; hence ketamine is known as a ‘dissociative anaesthetic’. This has two connotations. Firstly, it has a direct effect on the brain, inducing a lack of responsive awareness not only to pain but also to the environment around the user. Secondly, it gives a unique feeling of dissociation of the mind from the body (or the so-called ‘out-of-body experience’).

Sensory blockadesKetamine blocks or interferes with the sensory input of the central nervous system. The drug, in some ways, selectively interrupts association pathways of the brain before producing somaesthetic (the sensation of having a body) sensory blockades. Physically, ketamine has tangible effects too. It produces changes in your heart rate, cardiac output and blood pressure. If ketamine users are taken to A&E units, it’s usually because of tachycardia.

Psychologically, ketamine is enjoyed because it can give users a psychedelic state of mind. Clubbers call this ‘going down the K-hole’. The K-hole, a feeling akin to otherworldliness, allows the user to travel ‘beyond the boundaries of ordinary existence’. The intensity of these psychedelic effects is always dose-related. On a neuro-physiological level, this behaviour actually resembles schizophrenic psychosis.

Tolerance to ketamine develops quickly and often results in an escalation of dosage. Two large lines at a club can quickly become four large lines in a short period of time. It has the potential to cause psychological dependence in some individuals and yet the main ‘down’ effects of ketamine are anxiety, agitation and changes of perception, such as loss of a sense of danger or visual disturbances. In such a condition, the user may be at risk of injuring themselves without knowing it. When coupled with alcohol, falls can happen in night clubs, as can cigarette burns, walking into mirrors and tripping down steps. In London, where ketamine is far less popular, K-users are known derogatorily as ‘zombies’.

K-users may be physically incapable of moving while under the influence of the drug (you can see such casualties at any number of Kowloon KTV clubs). Ketamine can also produce panic attacks, depression, paranoia, and can make existing mental health problems far worse. It’s particularly dangerous when mixed with ecstasy, MDMA or amphetamines and can result in high blood pressure, unconsciousness and, most seriously of all, inhalation of vomit.

Research suggests that first-time users of ketamine tend to follow similar consumption patterns as those previously adopted for other drugs. Clubbers often inadvertently buy ecstasy tablets only to find they are ketamine pills, or vice versa. Unsuspecting people will be offered lines of coke only to discover they’ve snorted Calvin Klein, or pure ketamine. This can create psychological risks, especially when there is no warning or support. Indeed, the large numbers of users who head to emergency departments are those who have inadvertently taken ketamine by mistake and have thus experienced anxiety attacks. As for why people desire ketamine, please read on…

What’s your background?I was formally a registered teacher and in 1976 I joined the correctional service for the Prisons Department, retiring in 1997. Then I joined SARDA.

What’s SARDA?
The Society for the Aid and Rehabilitation of Drug Abuse. Convicted drug addicts are sent to prison by the courts, by law, so the treatment there is compulsory (see page 22). But SARDA is different, it’s voluntary; the largest treatment and rehabilitation organisation in Hong Kong. I was with SARDA for 10 years. I retired last year as their executive director.

What changes and trends have you seen in these past 30 years?
In the 1950s, more than 90 percent of the prison population was inside for drugs.

No, really?
Yes. Remember, before the Second World War, smoking opium was still legal. But after 1946 new laws were introduced. People couldn’t kill their habit in such a short time to avoid prison or punishment. Imagine being ordered to stop smoking cigarettes immediately – people can’t do it. The same goes with opium and heroin.

But why did heroin have such a hold over Hong Kong?
Because it’s six times stronger than opium, so why not? Hong Kong could get different grades of heroin, and ‘number 3 heroin’, which is cheap and not that pure, became the popular choice. That’s why they have the term ‘chasing the dragon’. You have the tin foil, you put the powder on it, you burn it under the foil and the smoke pops up like a dragon. With ‘number 4 heroin’ they didn’t need to chase the dragon. They shot it in their arm. It’s purer and you get 100 percent of the drug in your veins. No waste. The risk, of course, is overdose. I saw this throughout the 1980s. And then came MDMA, ecstasy and rave culture. Then from the 1990s along came ketamine.

…and ketamine became huge.
In South East Asia, and especially in Hong Kong, it became huge. The first reason was because of its availability. It’s made easily in South East Asia. The second reason is that ketamine is very powerful. It pops into the brain quickly. It gets you high very easily. Hongkongers like fast powerful drugs. Ketamine is everywhere. It gives you a complete retreat from the world.

Like going down the k-hole?
Exactly. But young girls taking ketamine worries me. Ketamine makes these girls relax at parties but if you take too much ketamine you lose your consciousness and it’s very easy to damage your brain. The most serious cases can damage your brain 70 percent. Most of the time women don’t have to pay for their ketamine; men give it to them. This is very attractive for them. And then you have those boat raves over at Sai Kung with alcohol and ketamine on board. Young girls are put in a very dangerous position. They take more than they should, lose all bodily control, and anything can happen; many girls can be raped. SARDA has ongoing treatment centres specifically for young girls, all under 21. It’s always full.

Why is ketamine so easy to buy here?
It’s very popular. In the 1970s heroin was handled by four major families. The gang families. But these families were dismantled and then connections grew outside Hong Kong. Ketamine is safe to buy. You buy it from social networks. It’s much safer to buy than heroin. Just go to LKF on any night, you can buy ketamine anywhere. You need a connection and then you can just buy it. The gangs and triad members and underworld people can distribute it easily. But remember, I know doctors and lawyers who use ketamine. All social classes here use ketamine.
Where is ketamine most popular?
The black spots are Mong Kok, TST, Chuen Wan, Yeung Long and Tuen Mun. The gangs have good networks, but the main source I feel is north China. It’s very dangerous to manufacture ketamine in Hong Kong. The police here are very smart, very clever and very few of them are corrupt. Mainland police are corrupt; not so here. It works several ways. Let me give you an example. A Hong Kong man will go to northern China, get a young poor wife and use her to traffic ketamine over the border.

How?
View attachment 22538
Swallowing condoms [full of drugs] or rectal. So many people come over the border. So many. So how can you check them all? It is very offensive to body search a woman without due cause. That’s a sensitive matter here. So this is easy money. Easy money.Ketamine sells like candy here…
I knew a man who had one kilo of ketamine pills and sold it for $10,000 within two hours. He said to the boss: “Give me two kilos!” So you get the picture. Everybody wants ketamine. Get out your Octopus card, chop up the lines, snort it. It’s sold by the gram. Depending on location, you can get it for around $77 a gram. A higher purity of ketamine is around $170 a gram. Purity is important.

And it gets to Hong Kong how?
Over the borders. There’s no shortage of supply [laughs]. Trafficking drugs is a very serious offence in Hong Kong. But I believe the Hong Kong narcotics division is one of the best in the world. The police are very good indeed.

And habits die hard?
You see, in a user’s mind, they don’t see [ketamine] as a serious habit. They think they can drop it any time.

What’s the treatment for ketamine abusers?
There are different types. Most doctors go for symptomatic treatments. There’s no real antidote drug for ketamine, so they look at symptoms and then issue a balancing drug. Valium is popular for treatment. But most important of all is counselling, as is continuous support. There’s no silver bullet solution. You need to council the person, speak with their family, and have support. Without family support you’ll only get 50 percent success. Drugaddiction, by definition, is chronic relapse, so we must offer continuous support.

Lost in the K hole - The police

The police in Hong Kong take a serious view on the trafficking, sale and consumption of ketamine in the city. Matt Fleming speaks to officers about K’s rapid rise... and the fall of those who peddle it

The Narcotics Bureau of Hong Kong Police Force deals with all crimes drug-related. And ketamine is a big concern, according to a spokesman.

How is ketamine sold on Hong Kong’s streets?
It is sold in the illicit market as a fine white crystalline powder. It is often packed in small, transparent resealable plastic bags. Sometimes it is folded in a paper wrap or in a banknote.

How is it being trafficked into Hong Kong? Is it coming in from Shenzhen or via the port?
Drugs such as ketamine are trafficked in through the land boundary with the Mainland and, on occasions, through the airport from other Asian regions.

Where is the drug being produced in labs? Is it mainly Northern China, as we’ve heard?
The ketamine seized in Hong Kong originates from other Asian regions and the Mainland.

Have there been any very big K busts?
As regards ‘very big ones’, there were several large seizures in individual cases in 2006. In January 2006, Police’s Narcotics Bureau seized 151kg in an individual case, which was quickly followed by a case involving 200kg in February of that year. In September 2006, NB seized 550kg in a single case, representing the largest ever seizure in Hong Kong.

What is the most common type of seizure?
Common seizures are from stop and search in the street, which involve people possessing amounts commensurate with self use. There have also been numerous interdictions at wholesale level – often in the range of 500g to 1kg, as the method of supplying the local market nowadays is by low volume-high frequency consignments of the drug. There have also been seizures in entertainment premises. A special concealment method in one case was that it was concealed in printer ink cartridges.

What people are dealing or taking ketamine? Is it a major problem over other drugs?
We accord a high priority to enforcement against ketamine offences as often young persons are the users. The majority of arrests are in respect of ketamine nowadays. We do encounter young persons (teenagers or in their 20s) selling it but some traffickers are older.

How prevalent is the drug in Hong Kong?
Most police drug arrests are in respect of ketamine. A total of 2,910 people were arrested in connection with the drug in Hong Kong last year compared to about 880 for heroin and 720 people for methamphetamine.

Where are the ‘hotspot’ areas?Ketamine dealing and abuse is fairly spread out in Hong Kong. As the drug is often used in entertainment premises, areas in Kowloon with a high concentration of such places often produce more cases for police than other areas.
How do you detect for ketamine?
Police do not normally use equipment for detecting ketamine. Many cases are detected from intelligence-led operations.
Do you use sniffer dogs?
On occasions in Hong Kong. Mainly labradors and a few malinois (Belgian shepherd dogs) – a total of around 30. For example, at road blocks, entertainment premises checks and following a drug raid in Hong Kong, a sniffer dog is used to check for concealed drugs.

Does ketamine use a lot of police resources?Ketamine trafficking and abuse is expected to be a protracted problem. Police will do their utmost to protect persons from drugs such as ketamine and we have the resources to do so.

What does the future hold? Do you see more ketamine coming into the city, or other drugs?
It is notoriously difficult to predict what will happen in the drugs trade. As mentioned earlier, the ketamine situation is likely to be with us for some time. It is considered unlikely that other drugs will supersede ketamine soon.

Time Out Hong Kong published a special feature after running a drug survey. The opening line, describing ketamine as 'tranquilising' gives an idea of the depth of the thinking. The feature is sensational. For example, the claim that ketamine can cause '70% brain damage' is unlikely to be able to be substantiated-- presumably it refers to ketamine users falling over and damaging themselves. The usual ideas about young girls being raped under the influence are repeated, although no evidence is offered. However, they have made some effort at balance by publishing the views of Dr Karl Jansen:

There is a further section about rehab:http://www.drugs-forum.com/forum/showthread.php?t=168717
Hong Kong has a rather primitive anti-drug campaign, based on "Just Say No"-- which Reagan might be amused to see-- which may be well meaning but obviously ineffectual. Despite Hong Kong supposedly being 'awash' with ketamine, the most obvious drug users noticeable to tourists around popular night spots are said to be those drinking alcohol, but that is not seen as a problem.

They made an attempt at balance and try to be informative to an extent, but somitek is right in saying that it is nothing new. Considering the numbers of people involved, you could say that the problems caused by the 'epidemic' are not very serious.

They aricle appeared after a survey conducted by Time Out HK into drug use, but the survey left a lot to be desired,